Cabozantinib for relapsed neuroblastoma: Single institution case series

Relapsed high‐risk neuroblastoma has few effective therapies currently available or in development. Cabozantinib is an Food and Drug Administration approved multitargeted tyrosine kinase inhibitor for select adult malignancies with preclinical data suggesting efficacy against neuroblastoma. A safe and tolerable dose has been identified for children, but its efficacy remains unknown. We describe four children with relapsed metastatic neuroblastoma treated with cabozantinib. All four patients had extended disease control (two complete responsesfor >12 months, 2 stable disease >6 months) with manageable predictable toxicities requiring dose reduction in two patients. We discuss the potential for the use of cabozantinib in neuroblastoma.     

Mirtazapine-induced acute angle closure

Acute angle closure (AAC) is an ocular emergency with symptoms including blurred vision, eye pain, headache, nausea, vomiting and reddening of the eye those results from increased intraocular pressure. This clinical condition can lead to permanent damage in vision, thus causing blindness by generating progressive and irreversible optic neuropathy if left untreated. There are several reasons of AAC, including several types of local and systemic medications; mainly sympathomimetics, cholinergics, anti-cholinergics, mydriatics, anti-histamines, antiepileptics like topiramate, tricyclic and tetracyclic antidepressants, serotonin reuptake inhibitors, antipsychotics, sulfa-based drugs and anticoagulants. Mirtazapine, a noradrenergic and specific serotonergic antidepressant, is an atypical antidepressant with a complex pharmacological profile. This case report describes a patient with major depressive disorder, who experienced AAC after the first dosage of mirtazapine treatment, and highlights the importance of close monitoring of individuals under antidepressant treatment particularly immediately after initiation of the drug.     

An art therapy intervention for symptoms of post-traumatic stress,depression and anxiety among Syrian refugee children

This study first examined the prevalence of psychological symptoms among Syrian refugee children (N = 64) and assessed the effect of an art therapy intervention on post-traumatic stress, depression and anxiety symptoms. The Stressful Life Events (SLE) Questionnaire was used to measure stressful and traumatic experiences. The main outcome measures were UCLA Post-Traumatic Stress Disorder Parent version, Child Depression Inventory and State-Trait Anxiety Scale. After the baseline assessment, a five-day art therapy intervention, which is based on Skills for Psychological Recovery, was implemented. Findings of the study indicated that 60.3% (N = 35) of Syrian children who participated had high risk to develop post-traumatic stress disorder (PTSD) according to the SLE scale. The 23.4% of the children had PTSD symptoms while the 17.6% showed severe depression symptoms. Moreover, the 14.4% of the children showed severe levels of state anxiety symptoms and the 31.1% showed severe levels of trait anxiety symptoms. Findings of the study indicated that trauma, depression and trait anxiety symptoms of children were significantly reduced at the post-assessment. However, for state anxiety scores, significant differences between pre- and post-assessments did not appear. Therefore, it could be said that art therapy may be an effective method to reduce post-traumatic stress disorder, depression and trait anxiety symptoms among refugee children.     

Physician attitudes about genetic testing for localized prostate cancer: A national survey of radiation oncologists and urologists

Introduction

Genetic testing has been recently put forth as a strategy to improve decision-making in the management of localized prostate cancer. Little is known about how frequently prostate cancer specialists are using these tests, or whether they consider them important or effective. We performed a national survey of radiation oncologists and urologists on their perceptions and self-reported use of genetic testing.

Steroid Refractory Chronic Graft-Versus-Host Disease: Cost-Effectiveness Analysis

Given the increasing incidence of chronic graft-versus-host disease (cGVHD) and its rapidly escalating costs due to many lines of drug treatments, we aimed to perform a meta-analysis to assess the comparative effectiveness of various treatment options. Using these results, we then conducted a cost-effectiveness analysis for the frequently utilized agents in steroid-refractory cGVHD. We searched for studies examining tacrolimus, sirolimus, rituximab, ruxolitinib, hydroxychloroquine, imatinib, bortezomib, ibrutinib, extracorporeal photopheresis, pomalidomide, and methotrexate. Studies with a median follow-up period shorter than 6 months and enrolling fewer than 5 patients were excluded. Meta-analysis for overall and organ system–specific GVHD response (overall response [ORR], complete response [CR], and partial response [PR]) was conducted for each intervention. Cost per CR and cost per CR?+?PR were calculated as the quotient of the 6-month direct treatment cost by CR and CR?+?PR. Forty-one studies involving 1047 patients were included. CR rates ranged from 7% to 30% with rituximab and methotrexate, respectively, and ORR ranged from 30% to 85% with tacrolimus and ruxolitinib, respectively. Cost per CR ranged from US$1,187,657 with ruxolitinib to US$680 with methotrexate. Cost per ORR ranged from US$453 for methotrexate to US$242,236 for ibrutinib. The most cost-effective strategy was methotrexate for all of the organ systems. Pomalidomide was found to be the least cost-effective treatment for eye, gastrointestinal, fascia/joint, skin, and oral GVHD, and imatinib was found to be the least cost-effective treatment for liver and extracorporeal photopheresis for lung GVHD. We observed huge cost-effectiveness differences among available agents. Attention to economic issues when treating cGVHD is important to recommend how treatments should be sequenced, knowing that many patients will cycle through available agents.     

Ventricular tachycardia due to perinatal asphyxia

Background

Perinatal asphyxia is known to precipitate myocardial dysfunction, rhythm abnormalities and congestive cardiac failure.

Case characteristics

A 2-day old neonate with perinatal asphyxia.

Observation

He developed shock secondary to ventricular tachycardia, and required synchronized cardioversion for reversion of abnormal rhythm.

Outcome

Reversal of arrhythmia leading to recovery.

Message

Early identification and management of ventricular tachycardia in neonate with perinatal asphyxia can be lifesaving.